Provider Demographics
NPI:1750016259
Name:GARDEN GROVE POST ACUTE LLC
Entity type:Organization
Organization Name:GARDEN GROVE POST ACUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHANMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-340-5191
Mailing Address - Street 1:12332 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1804
Mailing Address - Country:US
Mailing Address - Phone:805-340-5191
Mailing Address - Fax:
Practice Address - Street 1:12332 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1804
Practice Address - Country:US
Practice Address - Phone:714-534-1041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility